Ioanna-Giannoula Katsouri

Background/Objectives: Cognitive impairment is a core feature of schizophrenia and is closely associated with everyday functioning and participation. This study examined the effects of a 12-week occupation-based group occupational therapy intervention on cognitive functioning in adults with schizophrenia. Methods: In this two-arm randomized controlled trial, 86 adults with schizophrenia were randomly allocated to an intervention group (n = 44) or a treatment-as-usual control group (n = 42). The intervention combined cognitive activation with everyday tasks, problem-solving, and social and creative activities. Co-primary outcomes were the Mini-Mental State Examination (MMSE), Addenbrooke’s Cognitive Examination III (ACE-III) total score, and Clock Drawing Test (CDT). Secondary outcomes included the Mini-Addenbrooke’s Cognitive Examination (M-ACE), ACE-III domains, and Trail Making Test (TMT) Parts A and B completion times and error counts, assessed at baseline and post-intervention. Group × time effects were examined using repeated-measures analysis of variance. Results: All 86 participants completed the post-intervention assessment and were included in the analysis. Compared with treatment as usual alone, the intervention was associated with significantly greater improvements in MMSE, ACE-III total, M-ACE, TMT Part A completion time, and the ACE-III language and visuospatial domains. Partial η² values ranged from 0.17 to 0.43, with the largest effect observed for the ACE-III total score. Conclusions: Adding occupation-based group occupational therapy to usual care may improve global and domain-specific cognitive test performance in adults with schizophrenia. Further research should determine whether these changes are maintained and translate into everyday occupational performance and participation. This trial was retrospectively registered with ISRCTN (ISRCTN43725423).

Background/Objectives: Self-awareness constitutes a key metacognitive construct supporting self-regulation and adaptive functioning in aging. This systematic review examined how self-awareness fluctuates across the Alzheimer’s disease (AD) continuum and explored its associations with cognitive performance and neuroimaging markers. Methods: A systematic search was conducted in databases including PubMed, Scopus, Science Direct and Web of Science covering the period from 2016 to 2026, and the review was registered on the Open Science Framework (OSF). The selection process followed PRISMA guidelines, and a total of 334 studies were screened for eligibility while 42 met the inclusion criteria. Studies were eligible if they examined self-awareness in relation to cognitive and/or neuroimaging parameters, with individuals in the preclinical and clinical spectrum of AD as the reference population. Results: The included studies highlighted self-awareness as a dynamic construct closely linked to cognitive performance and neural integrity, with measurable deviations emerging along the continuum from subjective cognitive decline to dementia. Accordingly, the findings suggest that alterations in self-awareness may reflect the stage-dependent cognitive and neurobiological changes that characterize the progression of AD. Conclusions: Converging evidence suggests that assessing fluctuations of self-awareness, ranging from heightened awareness to reduced awareness, may contribute to the early identification of individuals at risk of progression across the AD continuum. However, the substantial methodological heterogeneity across studies precludes definitive conclusions regarding its clinical utility. Future longitudinal studies employing standardized assessment protocols are needed to determine whether these changes can reliably predict disease progression.

Background/Objectives: Sleep disturbances are increasingly implicated in age-related cognitive decline and may contribute to heterogeneity in cognitive and social–cognitive functioning in Mild Cognitive Impairment (MCI). Nevertheless, it remains unclear whether longitudinal actigraphy-derived sleep parameters predict social cognition, including theory of mind (ToM), across amnestic (aMCI) and non-amnestic (naMCI) MCI subtypes. This study examined longitudinal trajectories of cognitive control and ToM in individuals with aMCI and naMCI and healthy older adults, and investigated whether actigraphy-derived sleep indices prospectively predict subsequent cognitive control and higher-order social cognition across these groups. Methods: A total of 179 participants (46 healthy controls, 75 aMCI, 58 naMCI) were assessed across three waves over approximately 16–20 months. Actigraphy-derived sleep indices were obtained using wrist actigraphy. Cognitive control was assessed with Delis–Kaplan Executive Function System subtests, whereas ToM was evaluated through tasks involving non-literal language comprehension, metaphor and proverb interpretation, higher-order mentalizing, and emotion recognition. Longitudinal trajectories were examined using mixed-design ANOVAs, and prospective sleep effects were tested using longitudinal path models. Results: Both cognitive control and ToM declined over time in the MCI groups, whereas healthy controls showed relative stability. Subtype differences in cognitive control emerged primarily in higher-order planning and rule-monitoring processes, with naMCI showing greater impairment. ToM revealed a clearer and more consistent gradient (healthy controls > aMCI > naMCI), particularly in higher-order inferential tasks. Among the actigraphy-derived sleep indices, only TST prospectively predicted later ToM performance, whereas prospective associations with cognitive control were limited and inconsistent. Conclusions: Reduced sleep duration was prospectively associated with poorer subsequent performance in higher-order social cognition, independently of the executive-control measures examined. These findings highlight phenotypic heterogeneity across MCI subtypes and suggest that objectively measured sleep duration may serve as a clinically relevant longitudinal marker of social–cognitive vulnerability. Future studies are needed to determine whether interventions targeting sleep duration are associated with improved social–cognitive outcomes.

Advances in neonatal intensive care have transformed the survival rates of infants born prematurely, resulting in a growing demographic of children with early-arrival histories entering formal education systems. While severe, high-risk neurodevelopmental diagnoses are typically established during infancy, the more subtle, low-severity "echoes" of prematurity frequently remain dormant, manifesting later as significant barriers to occupational participation in the classroom. This narrative literature review synthesizes contemporary evidence regarding the educational experiences of children born preterm and examines the role of school-based occupational therapy (SBOT) in promoting occupational participation within inclusive educational environments. Deliberately shifting away from traditional bottom-up, deficit-remediation models that seek to "normalize" the child, this paper explores how the nuanced legacy of prematurity impacts the core occupations of the student-specifically academic performance, social participation, and play. Grounded in the Occupational Therapy Practice Framework: Domain and Process (4th ed.) and neurodiversity-affirming paradigms, the review highlights the central role of SBOTs in utilizing Universal Design for Learning (UDL), Multi-Tiered Systems of Support (MTSS), and environment-centric adaptations. Ultimately, the paper advocates for a top-down, collaborative, and systemic approach to optimize the occupational engagement of students navigating the late-emerging challenges of premature birth.

This systematic review evaluates the efficacy of interventions designed to enhance self-compassion in parents of children with neurodevelopmental disorders (NDDs), a population documented to experience elevated levels of parenting stress. Adhering to PRISMA guidelines, a search of PubMed, Scopus, and PsycINFO (covering the period 2015 to 2025) identified studies evaluating self-compassion educational programs, training, or workshops for parents of children with NDDs. Eligible studies included Randomized Controlled Trials (RCTs) and pre-post designs using a quantitative measure of self-compassion as the outcome. Eight studies were included, featuring varied interventions like Acceptance and Commitment Therapy (ACT), psychoeducation, and Mindfulness-Based approaches. The results suggest that these interventions are generally associated with significant short-term improvements in parental self-compassion and secondary outcomes including reduced stress and depression. However, the current evidence base is limited by methodological heterogeneity. Future research must prioritize rigorous RCTs and longitudinal follow-up to establish sustainable, evidence-based practices for this population.

Background: Preterm birth is a significant early-life stressor associated with increased psychiatric vulnerability and long-term functional impairments in school-aged children. Objective: To compare behavioral–emotional outcomes and functional competence between school-aged preterm and term-born children, examining perinatal, cognitive, and socioeconomic predictors. Methods: 140 children aged 6–10 (70 preterm, 70 age-matched controls) were assessed using the Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ). Functional competence—defined as participation in daily activities, social interactions, and school performance—was examined alongside behavioral–emotional outcomes. Predictors included gestational age, birth weight, SES, and cognitive ability. Results: Preterm birth was associated with higher SDQ scores in emotional problems, hyperactivity, and peer problems. CBCL results showed lower total functional competence scores, specifically in activities, social participation, and school performance. Longer NICU stay predicted higher internalizing problems and lower social participation. Cognitive ability was linked to lower SDQ externalizing and internalizing scores. SES was not a significant predictor. Conclusions: Preterm birth and prolonged NICU hospitalization are linked to persistent behavioral–emotional and functional vulnerabilities. These findings underscore the need for early, integrated developmental monitoring within a preventive psychiatry framework to identify psychiatric vulnerability and support functional participation.

Background/Objectives: Driving performance and competence represent a complex functional domain that may be affected in some individuals with schizophrenia. This scoping review aimed to map existing evidence characterizing driving-related functioning by identifying the cognitive, pharmacological and functional factors that influence driving ability and by synthesizing findings from experimental, neurocognitive and population-based studies. Methods: A structured search of the PubMed, Scopus and ScienceDirect databases was performed in accordance with PRISMA-ScR guidelines to identify studies published between 2015 and 2025 that examined cognitive, pharmacological and functional dimensions of driving in individuals with schizophrenia. Extracted data were narratively and thematically synthesized. Eleven studies met the inclusion criteria. Results: Findings clustered into three domains: cognitive, including attention, executive function, reaction time and visuospatial processing; pharmacological, encompassing drug comparisons, dosage, side effects and treatment stability; and functional, covering license status, driving participation, driving cessation, avoidance behaviors and self-regulation. Conclusions: This review integrates current evidence within a multidimensional and conditional framework, highlighting interactions between cognitive functioning, pharmacological factors, and compensatory self-regulation in individuals with schizophrenia. Understanding these interrelations may inform individualized fitness-to-drive evaluations and contribute to structured, context-sensitive interpretation of driving-related evidence in clinical and regulatory settings.

Background/Objectives: Sleep disturbances are increasingly recognized as dynamic biomarkers of cognitive decline; however, longitudinal and multimodal studies directly comparing amnestic (aMCI) and non-amnestic mild cognitive impairment (naMCI) remain limited. Methods: In a three-wave longitudinal design (~24 months), 179 older adults (46 healthy controls [HCs], 75 aMCI, 58 naMCI; mean age = 70.2 years, education = 12.3 years) were assessed with actigraphy and validated questionnaires (Athens Insomnia Scale, Pittsburgh Sleep Quality Index, STOP-BANG). Mixed ANOVAs and structural equation modeling tested group, time and mediation effects. Results: Subjective measures revealed a progressive worsening of insomnia and sleep quality in MCI, with naMCI exhibiting the steepest decline, while HCs remained largely stable. STOP-BANG trajectories indicated increasing sleep-disordered breathing risk across groups, most pronounced in naMCI. Objective indices corroborated these findings: total sleep time (TST) and sleep efficiency (SE) declined significantly in MCI, especially naMCI, while wake after sleep onset (WASO) increased longitudinally. By the third assessment, naMCI consistently showed the shortest TST and lowest SE. Mediation analyses identified SE as a central predictor of future subjective complaints, with indirect contributions from WASO and PSQI. Conclusions: Longitudinal trajectories, rather than cross-sectional comparisons, best differentiated MCI subtypes. NaMCI demonstrated the most aggressive deterioration in both objective and subjective sleep measures, highlighting its heightened vulnerability to sleep dysregulation and potential relevance for neurodegenerative progression. Clinically, sustained monitoring of SE, TST, and sleep-disordered breathing risk may provide prognostic value and inform early, targeted interventions in at-risk populations.

The early identification of cognitive decline is crucial for well-timed intervention and diagnosis, particularly in the context of preclinical Alzheimer’s disease (AD). In this study, we investigated the complex interplay between trait affect, objective cognitive performance, and subjective memory estimations in a sample of 105 older adults. Using path analysis, we aimed to determine whether trait affect and objective cognitive control abilities predict individuals’ subjective perceptions of their own memory abilities. The results revealed that both positive and negative trait affect significantly predicted subjective memory estimations, while objective cognitive control performance did not significantly predict these estimations. These findings highlight a crucial dissociation between objective and subjective cognitive measures. Therefore, the present results underscore the critical importance of complementing self-reported cognitive estimations, which can be biased by stable emotional dispositions, with objective cognitive tools like the R4Alz-pc (preclinical) index. This approach enables a more accurate evaluation of cognitive health in advancing age, especially for the early detection of subtle dysfunction in preclinical AD.